Provider Demographics
NPI:1205926722
Name:PHILLIPS, TERESA L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13219 POND CRK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26169
Mailing Address - Country:US
Mailing Address - Phone:304-420-7155
Mailing Address - Fax:304-420-7139
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:CAMDEN CLARK MEMORIAL HOSPITAL
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-420-7155
Practice Address - Fax:304-420-7139
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV39386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner